A Successful PACS Implementation

1
A Successful PACS Implementation

• Monte Clinton, CRA
• Dartmouth-Hitchcock Medical Center
• Brian Phelan
• IDX Corporation

2
Disclaimer

• This presentation is about a PACS implementation
  at one facility (DHMC) with one vendor (IDX) and
  is being given as an example of a successful PACS
  implementation
• Other facilities and vendors can do a similar
  PACS implementation using this partnering program
  and methodology
• DHMC does not endorse IDX or any other vendors
  products and services

3
Why Install a PACS?

• Save money Increase reimbursement
• Reduce medico-legal risk
• Eliminate Film and processing costs
• Reduce Film Library staff
• Improve billing collections
• Reduce medico-legal exposure

4
Why Install a PACS?

• Improve staff and imaging room productivity
• Increased staff productivity
• Reduction in the number of staff
• Increased imaging room productivity
• Eliminate imaging rooms

5
Productivity Benefits of DR Source Philips
Medical System
6
Why Install a PACS?

• Improve service to your customers
• Single set of film images limits collaboration
• Minimize lost studies and revenue
• Minimize treatment delays
• Speed service to referring clinician and patient

7
DHMCs Steps to Justify PACS

• Internal justification The major players
• Large capital or operating cost impact requires
  multiple levels of approval at DHMC this was
• Radiology
• Information Systems

8
DHMCs Steps to Justify PACS

• Internal justification Institutional leadership
• Administrative leadership
• Finance Committee
• Board of Trustees final go or no go

9
PACS Getting Started

• Outside experts PACS consultants
• Institutional experts
• Radiology
• Information Systems

10
PACS Getting Started

• Educate yourself about PACS
• Ask your colleagues about their experiences
• Attend meetings such as this one
• Vendor discussions and demonstrations at trade
  shows - AHRA, RSNA, SCAR

11
PACS Getting Started

• Request for Information (RFI)
• Invite selected vendors to respond to RFI
• Get a list of their customers to contact
• How would their system fit into your facility
• RIS and PACS compatibility

12
Interface or Integrate

• The critical relationship between the RIS and the
  PACS
• Have the RIS and the PACS vendors worked together
  before?
• Which vendor has primary responsibility or are
  you expected to do problem triage?

13
PACS Getting Started

• Request for
  proposal (RFP)
• Invite a limited number of vendors to bid
• Vendor clarification meetings
• RFP review and analysis
• Site visits at working clinical sites
• Final negotiation Purchasing and Vendors

14
Paying for a PACS

• Capital Purchase or Operating Expense
• Capital purchase
• Major capital expense compete for funding
• Cost to upgrade and remain technologically
  current
• Ongoing service and maintenance cost
• Application Service Provider (ASP)
• Costs are an operating expense
• Always kept technologically current
• All inclusive ASP charges fluctuate with revenue

15
The PACS Timeline

• Develop a realistic implementation timeline
  with buy-in from all affected stakeholders
• Radiology all levels
• Information Systems
• Institutional Leadership
• Referring Clinicians
• PACS Vendor

16
DHMCs PACS Timeline

• Phase 1
• 1-2003 Archiving started in CT, MR, US
• 4-2003 Live in CT, MR and US stop printing
  film
• Phase 2
• 9-2003 Archiving started in DX
• 12-2003 Live in DX stop printing film
• Phase 3
• 4-2004 Archiving started in Angio and NM
• 4-2004 Upgrade the RIS
• 4-2004 Live in Angio and NM

17
Partnering with PACS Vendor

• Agreement with the vendor on the timeline and
  implementation phases
• Appoint key staff from each stakeholder
• This must be a win win endeavor

18
Planning the Implementation

• Weekly meetings of the
• PACS Working Group
• Radiology Director
• Radiology PACS Administrator
• Radiology Clinical Operations Manager
• Radiology Asset Manager
• IS Director
• IS Liaison

19
Guiding the Implementation

• PACS Implementation Team
• bi-monthly meetings
• Chairman of Radiology
• Chief Information Officer
• Vice President of Clinical Operations
• The Six Working Group Members

20
Before and After Implementation

• Ongoing follow-up
• Weekly calls - Radiology and vendor
• Updates to the clinical departments
• Regular updates to the Board of Trustees
• Monthly updates to the Radiology faculty
• Weekly updates to the Radiology staff

21
Selecting the Hardware

• Involve the end user in equipment selection
• Radiologists given a choice of monitors
• Referring clinicians given a choice of monitors
• Specialty sections given choice of monitors
• OR selected from 5 large flat panel monitors
• ED selected the best monitor for their use

22
Reading Room Design

• Radiologists given a choice of layout
• DHMC rejected the modular systems
• Radiologists preferred two image monitors
• Room lighting critical
• Calculate room temperature requirements
• Gradual phase out of alternators

23
The Archive

• DHMCs PACS Archive
• In-house dual servers maintained and remotely
  monitored 24/7 by vendor
• External archive backed up daily to vendors San
  Diego archive facility
• DHMCs failsafe back-up archive -- DVDs burned
  daily and stored at DHMC

24
(No Transcript)
25
Training of the Radiologists

• Vendor provided 1 to 2 hours of one on one
  training 2 to 3 days before activation
• Return visits after activation for more
• training if needed
• Give them all the time and training they want
• Ask radiologists and residents to offer
  suggestions for enhancements

26
Keep Your Staff Informed

• Being upfront about what is happening and when it
  
• will impact the lives of staff will head off
  rumors
• Publish a PACS phase in plan DHMC 1 year
• Stop hiring permanent full time Film Library
• \employees a year before implementation
• Work with HR to find jobs for displaced staff

27
Contingency Plans

• Referring clinicians demanding film
• Acceptance of CD copies by other facilities
• Urgent results reporting
• Special requests
• System failure power failure, virus, etc.

28
Partner With Your Vendor

• Clear objectives spelled out in the contract
• Agree on timeline, payment and penalties
• Clearly define facility - vendor responsibilities
  
• Track progress with regular reports
• Make the PACS implementation a win win program
  for both your facility and the vendor

29
What DHMC Did Right

• Developed and used a workflow analysis
• Piloted PACS with 15 referring clinicians
• Had a close relationship with the PACS vendor
• Integrated modalities in advance
• Integrated RIS/PACS with electronic medical
  record

30
A Chairmans Perspective

• Never in my 29 years as a chairman have I made
  a decision that has received such universal
  acceptance from both the radiologists and the
  referring clinicians
• Peter Spiegel, MD
• Chairman Radiology

31
Contact Information

• Monte Clinton, CRA
• Dartmouth-Hitchcock Medical Center
• Monte.Clinton_at_Hitchcock.org
• www.dhmc.org/dept/radiology
• Brian Phelan
• IDX Corporation
• Brian_Phelan_at_IDX.com